Laserfiche WebLink
_ �� � 3 <br /> _? <br /> Please check one: New �C Addition <br /> JOB srrE 35Dc� `��.,.� ����e �-� <br /> Owner's Name ��� �'� ���C�e S''�' Telephone Number <br /> Mailing Address 3�G�� '��,�S t�_�e_ � � �t��-�:. <br /> Sprinkler Contract r's Name �v�.v�ro�.wU�,..�.�� �.���f�hone Number Lj�Z��d�� <br /> Contact Person 1�J��� �� `�l/r ( ���`'Y <br /> Mailing Address {�� ��`�'�. �� �.�L'`����c�{' �'���j� <br /> WATER SUPPLY � <br /> Lake Well � City <br /> -?�� � ` ,r- <br /> BACKFLOW DEVICE <br /> AVB PVB ",�_ RPZ <br /> Year of <br /> Make Model Manufacture uan i <br /> S rinklers � � � �C +^ � <br /> . � <br /> . c,�-,.� i �r � <br /> TOTAL <br /> HYDRAULIC CAI.CUI.ATIONS Design Data: Sq. Ft. <br /> Area of Application: <br /> Coverage per Sprinkler: Sq. Ft. <br /> No. of Sprinklers: GPM <br /> Total Water Required: <br /> PERMIT FEE CALCULATION $ 35.00 <br /> 1, permit Fee $ .50 <br /> 2. State Surchar�e. $ 1.50 <br /> 3, Mail-In Fee <br /> 4. TOTAL PERMIT F'EE (Add lines 1-3 above) $ ----- <br /> The undersigned hereby applies to the City for issuance of a Sprinkler System Permit, agrees <br /> to do all work in strict accordance with the ordinances of the City and State regulations, and <br /> ' certifies that all statements made on this application are complete, true and conect. <br /> - ''`�, � � Date 7- /l r l/� <br /> Applicant <br /> l �-�---� 1� <br /> ***********��* *�***********�**�********�**�******�****:�****************�***** <br /> Approved Approved with Corrections Denied <br /> Reviewed ,G�/ =—�-/� <br /> Date <br />